title: The effects, safety and acceptability of compact, pre-filled, autodisable injection devices when delivered by lay health workers.
abstract: OBJECTIVE
  To systematically assess (i) the effects and safety and (ii) the acceptability of using lay health workers (LHWs) to deliver vaccines and medicines to mothers and children through compact pre-filled autodisable devices (CPADs).
  
  
  METHODS
  We searched electronic databases and grey literature. For the systematic review of effects and safety, we sought randomised and non-randomised controlled trials, controlled before-after studies and interrupted time series studies. For the systematic review of acceptability, we sought qualitative studies. Two researchers independently carried out data extraction, study quality assessment and thematic analysis of the qualitative data.
  
  
  RESULTS
  No studies met our criteria for the review exploring the effects and safety of using LHWs to deliver CPADs. For the acceptability review, six qualitative studies assessed the acceptability of using LHWs to deliver hepatitis B vaccine, tetanus toxoid vaccine, gentamicin or oxytocin using Uniject™ devices. All studies took place in low- or middle-income countries and explored the perceptions of community members, LHWs, supervisors, health professionals or programme managers. Most of the studies were of low quality. Recipients generally accepted the intervention. Most health professionals were confident that LHWs could deliver the intervention with sufficient training and supervision, but some had problems delivering supervision. The LHWs perceived Uniject™ as effective and important and were motivated by positive responses from the community. However, some LHWs feared the consequences if harm should come to recipients.
  
  
  CONCLUSIONS
  Evidence of the effects and safety of using CPADs delivered by LHWs is lacking. Evidence regarding acceptability suggests that this intervention may be acceptable although LHWs may feel vulnerable to blame.
authors.affiliation: Norwegian Knowledge Centre for the Health Services, Oslo, Norway. Claire.glenton@kunnskapssenteret.no
authors.forename: Claire
authors.initials: C
authors.lastname: Glenton
authors.forename: Rajesh
authors.initials: R
authors.lastname: Khanna
authors.forename: Chris
authors.initials: C
authors.lastname: Morgan
authors.forename: Elin Strømme
authors.initials: ES
authors.lastname: Nilsen
mesh_terms: D001291:Attitude of Health Personnel; D002662:Child Health Services / Q000458:organization & administration; D002983:Clinical Competence; D003150:Community Health Workers; D004059:Diffusion of Innovation; D004209:Disposable Equipment / Q000592:standards; D004869:Equipment Safety / Q000592:standards*; D005260:Female; D006801:Humans; D007223:Infant; D007267:Injections / Q000295:instrumentation* / Q000523:psychology; D008427:Maternal Health Services / Q000458:organization & administration; D017060:Patient Satisfaction; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D011247:Pregnancy; D024382:Professional Role; D015397:Program Evaluation; D036301:Qualitative Research; D012107:Research Design; D013192:Staff Development; D014611:Vaccination / Q000379:methods
chemical_list: D004364:Pharmaceutical Preparations
keywords: compact, pre-filled, autodisable injection devices; lay health workers; qualitative metasynthesis; systematic review; task shifting